Provider Demographics
NPI:1447209135
Name:GOSSELIN, GARY J
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:GOSSELIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 33RD ST
Mailing Address - Street 2:APT 18-P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9463
Mailing Address - Country:US
Mailing Address - Phone:212-562-3290
Mailing Address - Fax:
Practice Address - Street 1:300 E 33RD ST
Practice Address - Street 2:APT 18-P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9463
Practice Address - Country:US
Practice Address - Phone:212-562-3290
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1921322084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry